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Balanced Turbo Field-Echo Sequence for MRI of Parotid Gland Diseases

¹ Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan.
² Philips Medical Systems, 2-13-37, Kohnan Minato-ku, Tokyo 108-8507, Japan.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Healthy 24-year-old woman. eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, mm = masseter muscle, mpm = medial pterygoid muscle, mr = mandibular ramus, pd = intraglandular main duct, rmv = retromandibular vein, st = Stensen duct. Representative axial balanced turbo field-echo (FE) MR image (TR/TE, 6.2/3.1; number of signal acquisitions, 2) shows parotid gland (arrowheads) and surrounding structures.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Healthy 24-year-old woman. eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, mm = masseter muscle, mpm = medial pterygoid muscle, mr = mandibular ramus, pd = intraglandular main duct, rmv = retromandibular vein, st = Stensen duct. Maximum-intensity-projection (MIP) image obtained from sequential axial balanced turbo FE MR images shows sialographic image of parotid duct and special relationship between gland and surrounding structures such as blood vessels.

View larger version (30K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Healthy 24-year-old woman. eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, mm = masseter muscle, mpm = medial pterygoid muscle, mr = mandibular ramus, pd = intraglandular main duct, rmv = retromandibular vein, st = Stensen duct. Targeted MIP image shows parotid duct.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —55-year-old man with Warthin's tumor of parotid gland. Representative axial balanced turbo field-echo (FE) MR image (TR/TE, 6.2/3.1; number of signal acquisitions, 2) shows multiple tumor masses (t) with homogeneous signals occupying deep part of parotid gland (arrowheads). eca = external carotid artery, n = lymph node, pd = intraglandular main duct, rmv = retromandibular vein.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —55-year-old man with Warthin's tumor of parotid gland. Maximum-intensity-projection (MIP) image obtained from sequential axial balanced turbo FE MR images shows course of displaced intraglandular main duct (pd) and branches from external carotid artery (arrowheads) around and through tumor (t).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —55-year-old man with Warthin's tumor of parotid gland. Volume-rendering image shows spatial relationship between tumor masses (t) and surrounding blood vessels (arrowheads, branches of external carotid artery) or intraglandular main duct (pd).

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —59-year-old woman with pleomorphic adenoma. eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, pav = posterior auricular vein, pd = intraglandular main duct, rmv = retromandibular vein. Representative axial balanced turbo field-echo (FE) MR image (TR/TE, 6.2/3.1; number of signal acquisitions, 2) shows lobulated tumor (t) in superficial portion of parotid gland (arrowheads). Tumor is heterogeneous in signal intensity and is distant from intraglandular main duct (pd).

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —59-year-old woman with pleomorphic adenoma. eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, pav = posterior auricular vein, pd = intraglandular main duct, rmv = retromandibular vein. Maximum-intensity-projection image obtained from sequential axial balanced turbo FE MR images shows tumor (t) is close to posterior auricular vein (pav).

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —59-year-old woman with pleomorphic adenoma. eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, pav = posterior auricular vein, pd = intraglandular main duct, rmv = retromandibular vein. Volume-rendering image shows spatial relationship between tumor masses (t) and surrounding blood vessels and intraglandular main duct (pd).

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —41-year-old woman with parotitis (sialodochitis). eca = external carotid artery, ejv = external jugular vein, ica = internal carotid artery, ijv = internal jugular vein, rmv = retromandibular vein. Representative axial balanced turbo field-echo (FE) MR image (TR/TE, 6.2/3.1; number of signal acquisitions, 2) shows dilated intraglandular main duct (pd). Parenchymal signals of parotid gland (arrowheads) are normal.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —41-year-old woman with parotitis (sialodochitis). eca = external carotid artery, ejv = external jugular vein, ica = internal carotid artery, ijv = internal jugular vein, rmv = retromandibular vein. Maximum-intensity-projection (MIP) image obtained from sequential axial balanced turbo FE MR images shows sausagelike dilatation of intraglandular main duct (pd).

View larger version (69K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —41-year-old woman with parotitis (sialodochitis). eca = external carotid artery, ejv = external jugular vein, ica = internal carotid artery, ijv = internal jugular vein, rmv = retromandibular vein. Target MIP for MR sialography shows dilated intraglandular main duct (pd) and ductules.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —60-year-old woman with Sjögren's syndrome (severely affected). eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, pd = intraglandular main duct, rmv = retromandibular vein. Representative axial balanced turbo field-echo (FE) MR image (TR/TE, 6.2/3.1; number of signal acquisitions, 2) shows high-intensity spots in parotid gland (arrowheads).

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —60-year-old woman with Sjögren's syndrome (severely affected). eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, pd = intraglandular main duct, rmv = retromandibular vein. Maximum-intensity-projection (MIP) image obtained from sequential axial balanced turbo FE images shows globular pattern of sialectasia involving superficial and deep portions of gland. Note cyst (lymphoepithelial cyst, arrowheads) formation in gland.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —60-year-old woman with Sjögren's syndrome (severely affected). eca = external carotid artery, ica = internal carotid artery, ijv = internal jugular vein, pd = intraglandular main duct, rmv = retromandibular vein. Targeted MIP image from MR sialography shows "fruit-laden tree" pattern that is characteristic of Sjögren's syndrome. Note cyst (arrowheads) formation in gland.

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